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Association between insulin resistance and coronary microcirculatory function and adverse cardiovascular events after

Jinrong Zhong1, Liming Tang1, Yuanfeng Zhang2

  • 1Department of General Practice, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China.

Frontiers in Cardiovascular Medicine
|January 21, 2026
PubMed

Insights

Insulin resistance (IR), measured by HOMA-IR, is linked to poor coronary microcirculation and higher major adverse cardiovascular events (MACE) risk in non-diabetic STEMI patients post-PCI.

Area of Science:

  • Cardiology
  • Metabolic Syndrome
  • Vascular Biology

Background:

  • Hyperglycemia and insulin resistance (IR) are prevalent in ST-segment elevation myocardial infarction (STEMI) patients.
  • The specific impact of IR on coronary microcirculation in non-diabetic STEMI patients undergoing Percutaneous Coronary Intervention (PCI) requires further elucidation.

Purpose of the Study:

  • To investigate the association between IR and coronary microcirculation function.
  • To determine the relationship between IR and the incidence of major adverse cardiovascular events (MACE) one year after PCI in non-diabetic STEMI patients.

Main Methods:

  • Retrospective analysis of 298 non-diabetic STEMI patients who underwent emergency PCI.
  • Patients categorized into tertiles based on Homeostasis Model Assessment of Insulin Resistance (HOMA-IR).
  • Coronary microcirculation assessed via Index of Microcirculatory Resistance (IMR) and Coronary Flow Reserve (CFR); MACE incidence evaluated at 1 year. Statistical analyses included correlation and regression models.

Main Results:

  • Higher HOMA-IR tertiles correlated with increased IMR and decreased CFR (P < 0.001).
  • Elevated HOMA-IR was an independent predictor of microcirculatory dysfunction (high IMR, low CFR).
  • Higher HOMA-IR levels were associated with a significantly increased 1-year MACE incidence and identified as an independent risk factor.

Conclusions:

  • In non-diabetic STEMI patients, elevated HOMA-IR is strongly linked to coronary microcirculatory dysfunction.
  • Higher HOMA-IR predicts an increased risk of 1-year MACE after PCI.
  • Routine HOMA-IR assessment could aid in identifying high-risk patients for tailored treatment strategies.
Abstract

Keywords:
Homeostasis Model Assessment of Insulin Resistance (HOMA-IR)ST-segment elevation myocardial infarctioncoronary microcirculationinsulin resistancemajor adverse cardiovascular events

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